Headaches, including migraine and tension-type headaches, are a huge medical concern in the United States, affecting more than 45 million Americans.

While some people are affected by headaches only intermittently, many have frequent debilitating symptoms that lead to work absences and loss of income.
The American Academy of Neurology and the American Headache Society recently published new guidelines for the prevention of migraine headaches, and the updated guidelines now endorse the use of several alternative therapies to help keep migraine headaches at bay.
The botanical supplement that received the most attention in the new guidelines is Petadolex, which is the herb butterbur. Studies have shown that 75 mg of Petadolex taken twice daily can reduce the frequency, duration and intensity of migraine headaches by close to 50 percent, which is comparable to many of the prescription medications used to prevent migraines.
Butterbur seems to work by reducing spasms in arteries in the brain; it also acts as an anti-inflammatory agent. Butterbur is also effective in reducing allergy symptoms, so if you have both migraine headaches and allergies, butterbur would be a good choice for you.
It is generally well tolerated, though in sensitive people it may actually cause headaches and allergic-type symptoms, especially in those who are allergic to ragweed, marigolds and similar plants. The main concern with butterbur however is that if not prepared properly, it can be contaminated with pyrrolizidine alkaloids, which are carcinogenic; they can also cause liver and kidney damage.
If you try butterbur, be sure to purchase a product that says "PA-Free," like Petadolex. Data suggest that Petadolex is safe in kids ages 6-17; it is not recommended in pregnancy or during lactation, however.
Other supplements may also help to prevent migraine headaches; magnesium is probably one of the best. Many people in the U.S. are felt to be magnesium-deficient, either from poor diet or from the daily consumption of stomach acid medications and diuretics.
Coffee, alcohol, soda and salt can also lower magnesium levels. The dose that seems to be the most effective for headache prevention is 600 mg of magnesium taken at bedtime. If you are prone to loose stools, look for magnesium glycinate or magnesium gluconate, which are less likely to cause diarrhea. If you have kidney disease, do not take high-dose magnesium supplements without talking with your doctor.
Coenzyme Q10 (ubiquinol) may also reduce headaches, usually by about 30 percent; studies have shown that 100 mg three times daily is the effective dose; kids need smaller doses. The main side effect from Coenzyme Q10 is on your wallet - it's expensive. Melatonin may also be useful for both migraines and cluster headaches; doses range from 3 to 10 mg at bedtime.
Feverfew has been one of the most popular herbs used to prevent migraines, though it may not work that well in capsule form. In England however, people traditionally chew two to three fresh feverfew leaves per day to prevent migraines, and in one study more than 70 percent of patients using feverfew in this way had reduced headaches.
Another treatment that can work wonders for migraine headaches is acupuncture. A review article published in 2009 by the well-respected Cochrane Collaboration suggested that acupuncture was at least as effective, and possibly even more effective, for migraine prevention than standard drug treatments, and it has fewer side effects to boot. Many alternative therapies take two to three months to take full effect, so be patient if you elect to try one of these.
And finally, don't forget about lifestyle changes. Stress is a huge trigger for migraine headaches, and daily relaxation techniques like biofeedback and meditation can be very helpful in reducing headache recurrence. Stick to a schedule of regular healthy meals and snacks, and don't skimp on sleep. With a healthy lifestyle and the addition of a few herbs and supplements, you should be able to significantly reduce your risk of migraines.
(Drs. Kay Judge and Maxine Barish-Wreden are medical directors of Sutter Downtown Integrative Medicine program in Sacramento, Calif. Have a question related to alternative medicine? Email adrenaline@sacbee.com.)